Submitting a request for Equipment or Home Modification

Please complete and return the relevant form to us:

• Equipment Request Form (DOCX 149.3 KB)
• Home Modifications Request and Agreement Form (DOCX 97.2 KB)

Alternatively, once a client is eligible for the Adults with Chronic Conditions funding stream (ACC) funding stream, therapists can raise Category 1 requests directly on the ALTER portal.

Along with the equipment or home modification request form, all Category 2 items must also be submitted with:

• Delegate Approval Request Form (DOCX 172.7 KB)
• Risk Rating and Priority Scoring Form (DOCX 126.3 KB), or for Communication devices Priority Scoring Communication and Assistive Technology (DOCX 170.8 KB)

Complex, customised equipment items

Complex, customised equipment items will require an Equipment selection agreement form   (DOCX 92.6 KB) to be completed by the client and referring therapist, once delegate approval for the item has been approved.